Nonablative Skin Rejuvenation Research Articles

The Resident Cosmetic Clinic: An Institutional Review and Outcomes Analysis of the Loma Linda University Experience.

As the number of dermatologists offering cosmetic procedures continues to increase, so does the need for hands-on exposure to cosmetic dermatology during residency. A resident cosmetic clinic (RCC) model presents as a mutually beneficial opportunity for trainees to obtain first-hand experience, while patients have access to more affordable pricing. (1) To assess volume and variety of cosmetic dermatological procedures during residency. (2) To compare Loma Linda University (LLU) Dermatology RCC data with national residency program data. (3) To provide guidance for other dermatology residency programs who wish to incorporate cosmetic training into their educational curriculum. In this cross-sectional, retrospective, chart review study, resident training in cosmetic procedures at the LLU RCC was quantified and compared with that of national program averages, minimums, and maximums as reported by the Accreditation Council for Graduate Medication Education. LLU RCC residents performed more nonablative skin rejuvenation, intense pulsed light, and soft tissue augmentation procedures as the resident surgeon compared with other dermatology residents across the nation. Institutional review highlights an unmet need for greater exposure to and training in a variety of dermatologic cosmetic procedures during residency. Practical considerations for achieving optimal learning experiences were provided through the implementation of a resident cosmetic clinic.

A Randomized, Prospective, Split-Face Pilot Study to Evaluate the Safety and Efficacy of 532-nm and 1,064-nm Picosecond-Domain Neodymium:Yttrium-Aluminum-Garnet Lasers Using a Diffractive Optical Element for Non-Ablative Skin Rejuvenation: Clinical and Histological Evaluation.

The advent of fractionated picosecond (ps) lasers has provided an opportunity to explore new ways of creating microinjuries in the skin to induce skin rejuvenation. To compare the efficacy and safety of diffractive optical element (DOE)-assisted ps neodymium: yttrium-aluminum-garnet (Nd:YAG) lasers with 532-nm and 1,064-nm wavelengths (532-nm and 1,064-nm Nd:YAG P-DOE) using a novel fractional handpiece for the treatment of photoaged skin. An ex vivo guinea pig skin experiment was performed by evaluating the histology of the skin after 532-nm Nd:YAG P-DOE irradiation. A randomized, prospective, split-face study was performed on eight subjects with 532-nm and 1,064-nm Nd:YAG P-DOE. Based on the histological evaluation using ex vivo guinea pig skin, a reasonable safety profile and the potential to generate effective skin rejuvenation was observed using the 532-nm Nd:YAG P-DOE. Results demonstrated that both 532- and 1,064-nm Nd:YAG P-DOE were similarly effective in improving skin texture and skin pores; however, 532-nm Nd:YAG P-DOE was more effective in treating dyspigmentation. At a preliminary level, this study revealed that 532-nm and 1,064-nm ps Nd:YAG lasers using DOE fractional technology may improve photoaged skin. In conclusion, 532-nm Nd:YAG P-DOE may be especially beneficial for skin with epidermal pigmentary lesions.

Potential Efficacy of Multiple-shot Long-pulsed 1,064-nm Nd:YAG in Nonablative Skin Rejuvenation: A Pilot Study

Potential Efficacy of Multiple-shot Long-pulsed 1,064-nm Nd:YAG in Nonablative Skin Rejuvenation: A Pilot Study

Temperature Depth Profiles Induced in Human Skin In Vivo Using Pulsed 975 nm Irradiation.

The aim of this study was to determine the temperature depth profiles induced in human skin in vivo by using a pulsed 975 nm diode laser (with 5 ms pulse duration) and compare them with those induced by the more common 532 nm (KTP) and 1,064 nm (Nd:YAG) lasers. Quantitative assessment of the energy deposition characteristics in human skin at 975 nm should help design of safe and effective treatment protocols when using such lasers. Temperature depth profiles induced in the human skin by the three lasers were determined using pulsed photothermal radiometry (PPTR). This technique involves time-resolved measurement of mid-infrared emission from the irradiated test site and reconstruction of the laser-induced temperature profiles using an earlier developed optimization algorithm. Measurements were performed on volar sides of the forearms in seven volunteers with healthy skin. At irradiation spot diameters of 3-4 mm, the radiant exposures were 0.24, 0.36, and 5.7 J/cm2 for the 975, 532, and 1,064 nm lasers, respectively. Upon normalization to the same radiant exposure of 1 J/cm 2 , the assessed maximum temperature rise in the epidermis averaged 0.8 °C for the 975 nm laser, 7.4 °C for the 532 nm, and 0.6 °C for the 1,064 nm laser. The characteristic subsurface depth to which 50% of the absorbed laser energy was deposited was on average 0.31 mm at 975 nm irradiation, and slightly deeper at 1,064 nm, and 0.15 mm at 532 nm. The experimentally obtained relations were reproduced in a dedicated numerical simulation. The assessed energy deposition characteristics show that the pulsed 975 nm diode laser is very suitable for controlled heating of the upper dermis as required, for example, for nonablative skin rejuvenation. The risks of nonselective overheating of the epidermis and subcutis are significantly reduced in comparison with irradiation at 532 and 1,064 nm, respectively. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.

Potential role of S100A8 in skin rejuvenation with the 1064-nm Q-switched Nd:YAG laser.

The 1064-nm Q-switched Nd:YAG laser is demonstrated to be effective for non-ablative skin rejuvenation, but the molecular mechanism by which dermis responses to laser-induced damage and initiates skin remodeling is still unclear. HaCaT cells and 3T3 skin fibroblasts were irradiated with the 1064-nm Q-switched Nd:YAG laser at the different doses. Then, cells were collected and lysed for PCR and Western blot analysis. Cell viability was detected by Cell Counting Kit-8 (CCK-8) before and after laser irradiation. The expressions of S100A8, advanced glycosylation end product-specific receptor (RAGE) and inflammatory cytokines in two cell lines were markedly upregulated after laser treatments. The PCR, Western blot, and ELISA analysis showed the significant increase of type I and III procollagen in the 3T3 cells treated with the 1064-nm laser. Interestingly, si S100A8 effectively inhibited the expression of cytokines and collagen, while S100A8 treatments significantly increased them. P-p38 and p-p65 levels were also elevated after the 1064-nm laser irradiation, which is positively related with S100A8. Cell viability and reactive oxygen species (ROS) levels were not changed, while the content of superoxidase dismutase (SOD) in two cells was increased after laser irradiation. Our results demonstrated that the overexpression of S100A8 induced by the 1064-nm laser irradiation triggered inflammatory reactions in skin cells. The inflammatory microenvironment and improvement of skin antioxidant capacity contribute to new collagen synthesis in the skin cells. Thus, S100A8 was required for laser-induced new collagen synthesis in skin cells. p38/MAPK and NF-κB signal pathways were involved in S100A8-mediated inflammatory reactions in response to laser irradiation.

Light-emitting diode red light therapy: evidence base for aesthetic indications

Non-invasive approaches to skin rejuvenation, such light-emitting diode (LED) red light therapy, are increasing in popularity owing to their affordability, effective treatment outcomes and minimal downtime. In contrast to traumatic ablative (e.g. laser resurfacing) and non-ablative (e.g. intense pulsed light) skin rejuvenation modalities, which induce secondary tissue repair by causing controlled damage to the epidermis or dermis, LED red light therapy is atraumatic and bypasses the initial destructive step by directly stimulating regenerative processes in the skin. Its mechanisms of action encompass increased cellular proliferation, as well as stimulation of tissue regeneration, through targeting fibroblasts, keratinocytes and immune cells (mast cells, neutrophils and macrophages), which can be stimulated using specific wavelengths with significant tissue penetration properties. A growing body of literature supports the safe use of this treatment modality in aesthetic medicine.

The Role of the CO2 Laser and Fractional CO2 Laser in Dermatology.

Tremendous advances have been made in the medical application of the laser in the past few decades. Many diseases in the dermatological field are now indications for laser treatment that qualify for reimbursement by many national health insurance systems. Among laser types, the carbon dioxide (CO2) laser remains an important system for the dermatologist. The lasers used in photosurgery have wavelengths that differ according to their intended use and are of various types, but the CO2 laser is one of the most widely used lasers in the dermatology field. With its wavelength in the mid-infrared at 10,600 nm, CO2 laser energy is wellabsorbed in water. As skin contains a very high water percentage, this makes the CO2 laser ideal for precise, safe ablation with good hemostasis. In addition to its efficacy in ablating benign raised lesions, the CO2 laser has been reported to be effective in the field of esthetic dermatology in the revision of acne scars as well as in photorejuvenation. With the addition of fractionation of the beam of energy into myriad microbeams, the fractional CO2 laser has offered a bridge between the frankly full ablative indications and the nonablative skin rejuvenation systems of the 2000s in the rejuvenation of photoaged skin on and off the face. The CO2 laser remains an efficient, precise and safe system for the dermatologist. Technological advances in CO2 laser construction have meant smaller spot sizes and greater precision for laser surgery, and more flexibility in tip sizes and protocols for fractional CO2 laser treatment. The range of dermatological applications of the CO2 laser is expected to continue to increase in the future.

Clinical efficacy of the dual-pulsed Q-switched neodymium:yttrium-aluminum-garnet laser: Comparison with conservative mode

The quality (Q)-switched neodymium:yttrium-aluminum-garnet (Nd:YAG) laser is one of the first non-ablative lasers to be used for facial resurfacing and photorejuvenation. Recently, the method of low-fluence Q-switched Nd:YAG lasers known as ‘laser toning’ has been used for non-ablative skin rejuvenation and for the treatment of melasma in Asian countries. We report our experience of using a novel Q-switched Nd:YAG laser that was operated as a dual pulse at half fluence and 140-μs intervals compared with conservative mode laser.

A comparison of Q-switched 1064 nm Nd:YAG laser and intense pulsed light in the nonablative rejuvenation on rat model

Background and objective: A variety of laser and IPL treatments with continued progress have been applied for nonablative skin rejuvenation; however, the complete understanding of working mechanisms and clinical appliance strategy is not clear. Materials and methods: The rats were divided into three groups and irradiated with Q-switched 1064 nm Nd:YAG laser and IPL. Image analysis, chemical colorimetry method, and real-time PCR (RT-PCR) were used to detect the dermal thickness, hydroxyproline, and the expression of III procollagen mRNA, respectively, at sequential time points following irradiation. In addition, the ultra-structure changes of rat skin were observed by TEM at 3 weeks after irradiation. Results: Two-light treatment contributed to increase in the dermal thickness, the hydroxyproline contents and the expression of III procollagen mRNA, and the dense arrangement of collagen. The effect of collagen synthesis and remodeling could last for at least 3 months after treatment, and the YAG group is more efficient than the IPL group. The expressions of procollagen type III mRNA reached peak level at 2 weeks. Conclusion: The effect of different lights depends on the wavelength and the penetrated depth; the best referential treatment interval of two kinds of lights for nonablative skin rejuvenation on rat skin is 2 weeks.

Energy deposition profile in human skin upon irradiation with a 1,342 nm Nd:YAP laser

Nd:YAP laser emitting at 1,342 nm appears promising for nonablative skin rejuvenation treatment, based on favorable absorption properties of water and melanin in this part of the spectrum. A quantitative determination of energy deposition characteristics of Nd:YAP in normal human skin should enable design of a safe and effective treatment protocol for future human studies. Energy deposition profile of a prototype Nd:YAP laser was determined using pulsed photothermal radiometry. This technique involves time-resolved measurement of mid-infrared emission from a sample after pulsed laser irradiation. The laser-induced temperature depth profile is reconstructed from the radiometric transients using a custom optimization algorithm, developed and tested earlier in our group. Measurements were performed on the extremities of four healthy volunteers at low radiant exposure (2.8 J/cm(2) ). For the purpose of comparison, energy deposition characteristics of commercial Nd:YAG and KTP lasers (at 1,064 and 532 nm, respectively), were also determined at the same test sites. On average, the Nd:YAP laser deposits 50% of the absorbed energy within the top 0.36 mm of skin and 90% within 0.86 mm, which is significantly shallower than the Nd:YAG laser. The ratio between the dermal versus epidermal heating is more favorable and shows a smaller inter- and intra-patient variance as compared to both Nd:YAG and KTP laser. Energy deposition characteristics of the 1,342 nm Nd:YAP laser are very suitable for controlled heating of the upper dermis, as required for nonablative skin rejuvenation. The risks of overheating the epidermis or subcutis should be significantly reduced in comparison with the 1,064 nm Nd:YAG laser.

Nonablative radiofrequency for skin rejuvenation: a review of the literature

Signs of aging skin include wrinkles and laxity. Reversing these signs is gaining more importance especially with increasing life expectancy. For many years, ablative lasers have been considered the gold standard for skin rejuvenation. However, the desire by both subjects and physicians to achieve this with minimal side effects and shorter recovery times led to the emergence of various nonablative modalities. Nonablative radiofrequency was described by many studies as an effective and safe procedure for skin tightening. Herein, the authors review the outcomes of the recent studies and the latest developments in nonablative radiofrequency skin rejuvenation.

Investigation of irradiation by different nonablative lasers on primary cultured skin fibroblasts

A variety of lasers with different wavelengths and biological effects are widely used for nonablative skin rejuvenation, but the underlying mechanisms have not been fully investigated. To investigate the effects of irradiation by different nonablative lasers on collagen synthesis and the antioxidant status of cultured fibroblasts to identify a possible mechanism for laser photorejuvenation. Cultured skin fibroblasts were irradiated with three different lasers: 532 nm potassium-titanyl phosphate (KTP), 1064 nm Q-switched neodymium:yttrium-aluminium-garnet (Nd:Yag) and 1064 nm long-pulse Nd:YAG, and production of collagen and changes in lactate dehydrogenase (LDH), malondialdehyde (MDA), superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) were assayed. Irradiation by all three lasers led to a marked increase in collagen production. Two major antioxidant enzymes, SOD and GSH, were significantly increased, whereas MDA was markedly reduced after laser irradiation. No change in LDH activity was found between nonirradiated and irradiated fibroblasts. This study indicates that the increased collagen synthesis by fibroblasts after laser treatment may be partly due to improved antioxidant capacity, which reduces oxidative stress and thus stimulates new collagen production.

Split-Face Comparison of Intense Pulsed Light and Nonablative 1,064-nm Q-Switched Laser in Skin Rejuvenation

Multiple nonablative skin rejuvenation techniques have been used to improve facial aging. To compare rejuvenation efficiency of intense pulsed light (IPL) with nonablative 1,064-nm Q-switched laser in Asian patients. Twelve female subjects were enrolled and received five sessions of treatments at 2-week intervals. A split-face study was performed, with IPL applied to the left side of the face and nonablative 1,064-nm Q-switched laser to the right side. All assessments showed significant skin rejuvenation. For the improvement of skin texture, pore size, and sebum secretion, similar efficiency from laser and IPL was observed. For lightening of skin tone and macula, the IPL was more efficient than the laser after the first treatment, although no further clinical improvement resulted after three treatments. The laser gradually lightened the skin tone and macula and was ultimately more efficient than the IPL after five treatments. A series of IPL and nonablative 1,064-nm Q-switched laser treatments were performed with similar efficiency and safety for the improvement in skin texture, pore size, and sebum secretion. IPL was faster, but nonablative 1,064-nm Q-switched laser was more effective in improving skin tone and macula.

A case series of facial depigmentation associated with low fluence q‐switched 1,064 nm Nd:YAG laser for skin rejuvenation and melasma

In recent years, "laser toning" using low fluence, large spot size, multiple passed Q-switched 1,064 nm Nd:YAG laser has gained much popularity in Asian countries for non-ablative skin rejuvenation and the treatment of melasma. This case series highlights one of the complications associated with laser toning, which is facial depigmentation. Fourteen patients with laser toning-associated facial depigmentation were assessed with cross-polarized and ultraviolet (UV) photographic images. The laser toning regimens received by these patients, as well as the treatment given for depigmentation, were analyzed retrospectively. All 14 patients were Chinese females, 9 of whom received laser toning for non-ablative skin rejuvenation and the other 5 for melasma. The treatment regimens received by these patients were highly variable. The total number of treatments received ranged from 6 to 50 (mean 22.07). In all cases, UV photographic images demonstrated facial mottled depigmentation. Laser toning failed to significantly improve melasma in all five patients. Five patients received targeted narrowband UVB for depigmentation with good clinical results. Laser toning with low fluence Q-switched 1,064 nm Nd:YAG laser for skin rejuvenation and melasma can be associated with mottled depigmentation. With laser toning being frequently performed, this complication may become more commonly encountered in clinical practice. The depigmentation can appear after only a few treatment sessions, and can cause much disfigurement, especially in cases with background melasma. Further studies on laser toning are needed with the view to optimizing efficacy and minimizing side-effects.

Epidermal and dermal changes in response to various skin rejuvenation methods

During the last years, a number of new devices have been developed to improve the dermal and epidermal signs of photo- and chronological skin ageing. There are well-established ablative and non-ablative skin resurfacing options using different lasers and light sources, but side effects have been observed frequently. A recently developed photorejuvenation method using non-thermal stimulation of skin cells with low energy and narrow band light has been termed photomodulation. Light emitting diodes are the ideal source of this kind of light that stimulate mitochondrial cell organelles leading to up-regulation of cytochrome electron transport pathway leading to mitochondrial DNA gene modulation. This paper reviews the most current knowledge of intrinsic and extrinsic changes of ageing and summarizes different systems for skin rejuvenation with focus on non-thermal non-ablative skin rejuvenation modalities.

Innovationen in der dermatologischen Lasertherapie

Dermatologic laser therapy is a rapidly-changing field with many new innovations. One of the most important is the introduction of fractional photothermolysis. This method is established for skin rejuvenation and acne scars; both the original non-ablative devices and newer ablative ones are available. While its side effects and the patient's downtime are considerably less than with ablative skin resurfacing, its efficacy is much better than non-ablative laser skin rejuvenation. This approach is also effective for melasma and other forms of hyperpigmentation in some patients. Successful reports exist also for treating other, more infrequent dermatoses. Another new procedure is laser lipolysis. It can be used as an adjunct to classical liposuction or as laser lipolysis alone. Fat lysis is achieved by laser energy via fibers that are inserted in the subcutaneous fat, and the additional heating of dermal tissue may lead to the reduction of side effects such as bleeding and to reduction of skin laxity. Nevertheless, the superiority of laser lipolysis to classical liposuction techniques is not yet established, and the ideal wavelengths and treatment parameters are not yet fully clear. There have been improvements in the therapy of vascular lesions, especially the use of longer, infrared wavelengths. In addition, there is early information on experimental therapeutic approaches for diseases normally not amenable to laser therapy such as onychomycosis, hemorrhoids and allergic rhinitis.

Nonablative skin rejuvenation devices and the role of heat shock protein 70: results of a human skin explant model

Nonablative thermal laser therapy with a 1,540-nm laser induces controlled, spatially determined thermal damage, allowing subsequent collagen remodeling while preserving the epidermis. A photorejuvenation effect using nonthermal nonablative stimulation of cells with low energy and narrow band light has been termed photomodulation. Light emitting diodes (LEDs) are narrow band emitters that lead to photomodulation via stimulation of mitochondrial cell organelles. In a previous study, we demonstrated in a human skin explant model that heat shock protein 70 (HSP70) plays a pivotal role in the initiation of skin remodeling after ablative fractional photothermolysis. To test its importance in nonablative laser therapy and photomodulation, the spatio-temporal expression of HSP70 is investigated in response to a 1540-nm laser treatment and six different LED therapies. An Er:glass laser is used with a 1-Hz repetition rate, 30-J/cm(2) fluence, and a hand piece with a 2-mm spot size. Nonthermal nonablative treatment is performed using two LED (LEDA SCR red light: 635 nm, 40 to 120 W/cm(2), 40 to 120 J/cm(2); LEDA SCR yellow light: 585 nm, 16 to 35 W/cm(2), 20 to 100 J/cm(2); spot size 16 x 10 cm). Immediate responses as well as responses 1, 3, or 7 days postprocedure are studied; untreated skin explants serve as control. Immunohistochemical investigation (HSP70) is performed in all native, nontreated, and Er:glass laser- or LED-treated samples (n=175). Nonablative laser therapy leads to a clear time-dependent induction of epidermally expressed HSP70, peaking between one to three days post-treatment. In contrast, none of the various LED treatments up-regulated the HSP70 expression in our skin explant model. HSP70 is up-regulated by nonablative but thermal laser devices, but does not seem to play a significant role in the induction of skin remodeling induced by photomodulation. The maximum of HSP70 expression is reached later after Er:glass laser intervention compared to ablative fractional (AFP) treatment.

Non-invasive Peri-orbital Rejuvenation: Radiofrequency Dual Radiowave Energy Source (RF) and Light Emission Diode System (LED)

Introduction: Non-ablative skin rejuvenation is becoming increasingly popular. Ellman RF produces an electric current that generates heat in the dermis producing a contraction of the collagen. LED is a non heating light emission system that induces fibroblast proliferation.Materials and methods: 30 Caucasian women, prototype I-IV, age from 35 to 65 with peri-orbital photo damage were randomly divided in 3 groups. Group 1 received: 5 RF sessions, 1 every 10 days. Group 2 received 8 LED sessions, 1 every 5 days. Group 3 received RF and LED: 1 RF, 2 LED sessions every 5 days for 3 times (3 RF and 6 LED sessions). A score of satisfaction, considering skin texture, rhytidis reduction and firmness was obtained before the treatment, after each session and 2 months after the last session.Results: Two months after the last treatment in group 1:7 patients were satisfied and 3 were very satisfied; in group 2: 6 patients were satisfied and 4 were very satisfied, in group 3: 4 patients were satisfied and 6 were very satisfied. LED was effective on improvement of skin texture and rhytidis reduction while slightly effective on firmness. RF was effective on skin texture and firmness while slightly effective on rhytidis reduction. LED and RF together were effective on all parameters.Conclusion: LED and RF seem to be safe and effective on skin rejuvenation especially when associated.

Non-invasive Peri-orbital Rejuvenation: Radiofrequency Dual Radiowave Energy Source (RF) and Light Emission Diode System (LED)

Non-ablative skin rejuvenation is becoming increasingly popular. Ellman RF produces an electric current that generates heat in the dermis producing a contraction of the collagen. LED is a non heating light emission system that induces fibroblast proliferation.30 Caucasian women, prototype I-IV, age from 35 to 65 with peri-orbital photo damage were randomly divided in 3 groups. Group 1 received: 5 RF sessions, 1 every 10 days. Group 2 received 8 LED sessions, 1 every 5 days. Group 3 received RF and LED: 1 RF, 2 LED sessions every 5 days for 3 times (3 RF and 6 LED sessions). A score of satisfaction, considering skin texture, rhytidis reduction and firmness was obtained before the treatment, after each session and 2 months after the last session.Two months after the last treatment in group 1:7 patients were satisfied and 3 were very satisfied; in group 2: 6 patients were satisfied and 4 were very satisfied, in group 3: 4 patients were satisfied and 6 were very satisfied. LED was effective on improvement of skin texture and rhytidis reduction while slightly effective on firmness. RF was effective on skin texture and firmness while slightly effective on rhytidis reduction. LED and RF together were effective on all parameters.LED and RF seem to be safe and effective on skin rejuvenation especially when associated.

Recent Trends in Cosmetic and Surgical Procedure Volumes in Dermatologic Surgery

The number of cosmetic and noncosmetic surgical procedures performed by dermatologic surgeons has been rising rapidly, but there are few consistent data sources allowing procedure volumes to be tracked over time. American Society for Dermatologic Surgery member survey in 2001 to 2007 reporting cosmetic and noncosmetic procedural volumes (300-500 surgeons surveyed, response rate of 31-44%). In 2001, dermatologic surgeons performed an estimated 3.4 million cosmetic and noncosmetic surgical procedures; in 2007, it was estimated that a total of 7.6 million procedures were performed (120.2% rate of growth between 2001 and 2007). The procedures with the greatest increase during this time period were soft tissue augmentation (405.0% increase), botulinum toxin injections (324.4% increase), and nonablative skin rejuvenation (laser, light, and radiofrequency sources) (330.7% increase). More modest increases were noted in skin cancer procedures (85.8% increase) and ablative resurfacing procedures (66.8% increase). The magnitude of growth in procedural volumes over the last 8 years reflects the advancements in dermatologic surgery in treatments for skin cancer and in treatment of photoaging and cosmetic enhancement of the skin. The authors have indicated no significant interest with commercial supporters.